First signs of schizophrenia in teen?

[Anonymous]

Brother is schizo-affective, which is like schizophrenia +depression.

Hygeine is a big one. I know a lot of tweens/teens aren't yet figuring out how to keep the stink off, but if the resistance to keeping clean and/or brushing teeth gets a lot worse or is way worse than other children you've raised, that could be an early sign.

Mayo clinic notes that onset before 18 is rare & typically does not begin with hallucinations and delusions, as it does with college-age patients.

But the most important early treatment is after the first psychotic break -- and you wouldn't be able to miss that, sadly.

from NIH: schizophrenia and depression share eight of the ten most frequent initial symptoms, with fairly similar ranks. Significant differences are limited to nervousness/restlessness and blunted affect, more frequent in schizophrenia, and depressed mood, more frequent in depression. A diagnostic distinction does not seem feasible at this early stage.

(Blunted affect means their facial expressions/voice does not show emotion as you would expect when interacting with others)

The aim of early intervention at the prepsychotic prodromal stage is to alleviate depressive and negative symptoms, functional impairment and its social consequences by cognitive-behavioral therapy and social skills training. There is no indication for antipsychotic pharmacological treatment until psychotic symptoms occur.

[social skills training can be either group therapy or just social skills groups]

[Anonymous]

Anonymous wrote:Pp here...I loved her so much and it was so painful to watch her go through what she did and feel helpless about how to help her. I think she's been in and out of group homes and is living with her parents possibly.

Heartbreaking.

[Anonymous]

Anonymous wrote:Brother is schizo-affective, which is like schizophrenia +depression.

Hygeine is a big one. I know a lot of tweens/teens aren't yet figuring out how to keep the stink off, but if the resistance to keeping clean and/or brushing teeth gets a lot worse or is way worse than other children you've raised, that could be an early sign.

Mayo clinic notes that onset before 18 is rare & typically does not begin with hallucinations and delusions, as it does with college-age patients.

But the most important early treatment is after the first psychotic break -- and you wouldn't be able to miss that, sadly.

from NIH: schizophrenia and depression share eight of the ten most frequent initial symptoms, with fairly similar ranks. Significant differences are limited to nervousness/restlessness and blunted affect, more frequent in schizophrenia, and depressed mood, more frequent in depression. A diagnostic distinction does not seem feasible at this early stage.

(Blunted affect means their facial expressions/voice does not show emotion as you would expect when interacting with others)

The aim of early intervention at the prepsychotic prodromal stage is to alleviate depressive and negative symptoms, functional impairment and its social consequences by cognitive-behavioral therapy and social skills training. There is no indication for antipsychotic pharmacological treatment until psychotic symptoms occur.

[social skills training can be either group therapy or just social skills groups]

PP, are you able to share more about your brother, including age of onset, age now, and what your brother is doing?

[Anonymous]

Pp with schizophrenic sister. She also had the blunted affect.

[Anonymous]

I would strongly disagree that you can treat schizophrenia with therapy only. Each psychotic episode often decreases brain matter. Long time untreated schizophrenia patients even have big spaces in their brains on an MRI. It can take at least several months to get out of a big episode.

I’m not sure where this NIH page is found. Here’s what I found.

https://www.nimh.nih.gov/health/topics/schizophrenia

[Anonymous]

Anonymous wrote:I would strongly disagree that you can treat schizophrenia with therapy only. Each psychotic episode often decreases brain matter. Long time untreated schizophrenia patients even have big spaces in their brains on an MRI. It can take at least several months to get out of a big episode.

I’m not sure where this NIH page is found. Here’s what I found.

https://www.nimh.nih.gov/health/topics/schizophrenia

No, that's not what that article was saying. It was saying that you can't distinguish very early schizophrenia from depression, although flattened affect is more common with very early schizophrenia than with depression, you can't make a dx based on that although you can try to alleviate the symptoms with therapy.

[Anonymous]

Anonymous wrote:I would strongly disagree that you can treat schizophrenia with therapy only. Each psychotic episode often decreases brain matter. Long time untreated schizophrenia patients even have big spaces in their brains on an MRI. It can take at least several months to get out of a big episode.

I’m not sure where this NIH page is found. Here’s what I found.

https://www.nimh.nih.gov/health/topics/schizophrenia

Is there anyone on here suggesting therapy only? I don't think so.

[Anonymous]

Anonymous wrote:I would strongly disagree that you can treat schizophrenia with therapy only. Each psychotic episode often decreases brain matter. Long time untreated schizophrenia patients even have big spaces in their brains on an MRI. It can take at least several months to get out of a big episode.

I’m not sure where this NIH page is found. Here’s what I found.

https://www.nimh.nih.gov/health/topics/schizophrenia

Where do you read about brain matter decreasing and large spaces in their brains?

[Anonymous]

I'm the PP sister who shared about NIH article -- and yes, the NIH /doctors definitely do NOT say schizophrenia doesn't need meds, and you are right, each untreated psychotic episode makes it harder to recover. As another reader said, the issue is that pre-schizophrenia is not easily detected.

My brother was in special ed for 'emotionally disturbed' (as they called it at that time) starting in third grade, I think? My brother is in his mid-50s, so special ed was very different back then. But that certainly wasn't for schizophrenia...

I am not totally sure when he was diagnosed, as he spent a lot of time in mental hospitals as a teen, but I guess before 18.

He is doing pretty good now. I later dated a psychiatrist, and she told me a lot of schizophrenics 'burn out' in middle age, and I think it's true of him. What she meant by that is that the negative symptoms remain -- difficulty meeting social expectations/hygeine -- but the florid symptoms subside.

He lives in a supported apartment with a couple of other guys with serious mental illnesses. It has been a long time since has needed to be hospitalized, even briefly (15 years?). Switching from Risperdal to Abilify (something I pushed for) seemed to be a quality of life improvement.

He became very religious as a young adult, and has found acceptance in that religious community & made friends with past group home staff, as well as a family that welcomes him to his home for dinner most weeks (he does not live near me/my parents).

He feels bad about himself in that he's never been able to have a real romantic relationship, and only worked briefly in minimum wage jobs in his very early 20s, but the social services agency that serves him just recently said the IT work he does for them (he is self-taught) is valuable enough they want to start paying him rather than having him volunteer. He'll have to keep his wages low enough he can stay on Social Security Disability/Medicare, but he is *very* proud of himself, as are we.

Not an inspirational story. But I'll offer one now -- I had a roommate who had severe bipolar (how I learned about Abilify) with psychotic episodes, who was twice homeless when he was unmedicated and completely untethered from reality, who now is married with two kids, and a decent paying professional job! [The second time was so sad -- he was taking meds he bought online from Canada and they turned out to be counterfeit; he felt himself going wrong and checked himself into a hospital, but got worse the next day or two and checked himself out against medical advice. His mom would find him on the street and try to convince him to come back but he was too off his head to listen...but he finally did and got back on meds.] You would never know he has a severe mental illness at all unless he told you about his life.

[Anonymous]

Anonymous wrote:I'm the PP sister who shared about NIH article -- and yes, the NIH /doctors definitely do NOT say schizophrenia doesn't need meds, and you are right, each untreated psychotic episode makes it harder to recover. As another reader said, the issue is that pre-schizophrenia is not easily detected.

My brother was in special ed for 'emotionally disturbed' (as they called it at that time) starting in third grade, I think? My brother is in his mid-50s, so special ed was very different back then. But that certainly wasn't for schizophrenia...

I am not totally sure when he was diagnosed, as he spent a lot of time in mental hospitals as a teen, but I guess before 18.

He is doing pretty good now. I later dated a psychiatrist, and she told me a lot of schizophrenics 'burn out' in middle age, and I think it's true of him. What she meant by that is that the negative symptoms remain -- difficulty meeting social expectations/hygeine -- but the florid symptoms subside.

He lives in a supported apartment with a couple of other guys with serious mental illnesses. It has been a long time since has needed to be hospitalized, even briefly (15 years?). Switching from Risperdal to Abilify (something I pushed for) seemed to be a quality of life improvement.

He became very religious as a young adult, and has found acceptance in that religious community & made friends with past group home staff, as well as a family that welcomes him to his home for dinner most weeks (he does not live near me/my parents).

He feels bad about himself in that he's never been able to have a real romantic relationship, and only worked briefly in minimum wage jobs in his very early 20s, but the social services agency that serves him just recently said the IT work he does for them (he is self-taught) is valuable enough they want to start paying him rather than having him volunteer. He'll have to keep his wages low enough he can stay on Social Security Disability/Medicare, but he is *very* proud of himself, as are we.

Not an inspirational story. But I'll offer one now -- I had a roommate who had severe bipolar (how I learned about Abilify) with psychotic episodes, who was twice homeless when he was unmedicated and completely untethered from reality, who now is married with two kids, and a decent paying professional job! [The second time was so sad -- he was taking meds he bought online from Canada and they turned out to be counterfeit; he felt himself going wrong and checked himself into a hospital, but got worse the next day or two and checked himself out against medical advice. His mom would find him on the street and try to convince him to come back but he was too off his head to listen...but he finally did and got back on meds.] You would never know he has a severe mental illness at all unless he told you about his life.

NP to this thread. Thank you for taking the time to write up all of this. It's so helpful, as someone with a family member in the same situation. And great to hear the inspirational story. Hugs to you and your brother.

If there's one thing that you get from having a family member with severe mental illness, it's empathy.

[Anonymous]

Here was my brother's progression, we didn't know he was also using drugs starting at age 12
1. Disordered Eating around age 14/15
2. Punching holes in walls, drawing strange things on mirrors and walls around age 15
3. Delusions around age 16 (e.g. thinking he had certain jobs that he did not have, thought he was friends with celebrities).
4. Disappearing for lengths of time, increased delusions around age 18